Inhaled foreign body overlooked for 25 years in an adult

A 30-year-old man was admitted to our hospital because of refractory pneumonia. He had been repeatedly hospitalized owing to pneumonia recurring in the left lower lung field and had a 7-day history of hemoptysis at the age of 11. Chest computed tomography demonstrated reduced volume of the left lower lobe with parenchymal consolidation. The patient preferred surgery as first-line treatment rather than other interventions because he had suffered from refractory pneumonia or local pleuritis for a long time. Left lower lobectomy was performed. The resected specimen revealed obstruction of the posterior basal segment bronchus in which a foreign body (FB) was found embedded in granulation tissue. The FB was a plastic air-pistol pellet. After further questioning, the patient remembered aspirating the pellet while playing with the pistol at the age of 5. When it is difficult to remove a long-standing intrabronchial FB, we recommend surgery.